危重患儿急性胃肠功能衰竭的病因、死亡危险因素分析和干预措施

Etiology,mortality risk factors and interference of acute gastrointestinal failure in critically ill children

目的了解PICU危重患儿发生急性胃肠功能衰竭的病因、流行病学特点和死亡危险因素。方法总结1999年1月-2004年12月我院PICU危重患儿急性胃肠功能衰竭的病因、预后与多器官功能衰竭（MODS）的关系，对死亡危险因素进行单因素分析。结果1788例危重患儿中569例发生急性胃肠功能衰竭，病死率29．3％，6年间病死率无明显变化（X^2=0．357，P=0．896）。严重感染、严重低氧血症和酸中毒、意外伤害、急性脑功能障碍是急性胃肠功能衰竭的常见病因。分别占39．4％、27．9％、16．7％和16．0％。对9种死亡因素进行统计学分析结果表明年龄、入院当天的危重病评分值、合并的基础疾病、血红蛋白显著下降、胃液pH值、血糖浓度异常、严重低氧血症和酸中毒、合并器官功能衰竭数目和休克与病死率显著相关（P〈0．05或P〈0．001）。结论1999年以来。急性胃肠功能衰竭病死率依然很高。严重感染、严重低氧血症和酸中毒、意外伤害、急性脑功能障碍是其发生的主要危险因素；患儿年龄小于1岁、危重病评分低及合并MODS是其死亡的主要危险因素。除治疗原发疾病、调整内环境、改善微循环外，还可通过提供最佳营养支持、维护胃肠黏膜屏障及外科治疗等措施，以期降低急性胃肠功能衰竭患儿的病死率。

Objective To study etiology, clinical epidemiology and mortality risk factors of critically ill children with gastrointestinal failure （GIF） in pediatric intensive care unit （PICU）. Methods The 1788 critically ill children with GIF admitted to PICU in Children＇s Hospital Affiliated to FuDan University during the period from January, 1999 to December, 2004 were reviewed for etiology, mortality rate, prognosis and relationship with multiple organ dysfunctions （MODS）. Univariate analysis was performed to identify mortality risk factors of GIF. Results During six years, 569 patients of the 1788 critically ill children developed GIF. The overall mortality of the patients with GIF was 29.3 %. There was no significant difference in yearly mortality of the patients with GIF from 1999 to 2004 （X^2 = 0. 357, P = 0. 896）. The common causes of GIF were severe infection （39.4 % ）, severe hypoxia and acidosis （27.9 % ）, accidental injuries （16.7 % ） and acute brain dysfunction （ 16.0 % ）. The epidemiological analyses identified nine risk factors ： younger age, lower pediatric critical illness score at admitting to PICU, underlying diseases, hypohemoglobinemia, gastric fluid pH, blood glucose, hypoxia combined with acidosis, the number of failed organ system（s） and shock （P 〈 0.05 or P 〈 0. 001 ）. Conclusion The mortality of the patients with GIF has remained high ever since 1999. Severe infection, hypoxia and acidosis, accidental injuries and acute brain dysfunction were the leading causes of GIF in PICU. Younger age, lower pediatric critical illness score and MODS indicated a higher mortality rate. To reduce the mortality of the patients with GIF there are many ways such as curing underlying diseases, adjusting internal environment, improving microcirculation, providing adequate nutrition support, protecting gastrointestinal mucous function, surgical procedure and so on.